Anatomy - Inferoposterolateral infarction

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This image shows a very severe stenosis in the proximal RCA. As seen in the ECG tracing this stenosis resulted to subendocardial ischemia of the inferoposterior myocardium.

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This ECG tracing shows ischemia as a result of a severe stenosis in the proximal RCA. Negative T waves are visible in the inferior leads II, III, and aVF. Hyperacute T waves are present in the anterior lead V2. In the ECG tracings of patients with RCA stenosis, hyperacute T waves can be seen in the anterior leads V1 and V2 (sometimes including V3 and V4) as a result of reciprocal subendocardial ischemic changes in the virtual posterior leads. Since posterior leads are not used in a standard 12-lead ECG, the supposed T wave inversion in the posterior leads are mirrored as hyperacute T waves in the anterior leads. In the ECG tracing above, negative T waves are also present in the lateral leads V5 and V6 as a result of the compromised blood flow in the posterolateral branch of the RCA.

Inferoposterolateral infarction may be caused by an occlusion in a dominant RCA or an occlusion in a dominant RCx. In most cases the culprit coronary artery is the RCx. In inferoposterolateral infarction secondary to RCx occlusion, the ischemia vector in the horizontal plane points to the posterolateral region of the left ventricle resulting in ST elevation in leads V5 and V6.

 

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